Provider Demographics
NPI:1235274663
Name:ATKINS, TRACI V (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:V
Last Name:ATKINS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 HARRODSBURG RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2112
Mailing Address - Country:US
Mailing Address - Phone:859-278-9492
Mailing Address - Fax:859-277-3027
Practice Address - Street 1:2424 HARRODSBURG RD STE 200
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2112
Practice Address - Country:US
Practice Address - Phone:859-278-9492
Practice Address - Fax:859-277-3027
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3688P208000000X
KY3003688363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78009396Medicaid
KY00450002Medicare PIN